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STATE OF MAINE DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF LICENSING AND CERTIFICATION Workforce Development Program Temporary Nurse Agency ApplicationSECTION 1: Provider Information Agency
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What is section 1 provider information?
Section 1 provider information includes details about the healthcare provider or entity that rendered the services.
Who is required to file section 1 provider information?
The individual or entity responsible for submitting the claim or reimbursement request is required to file section 1 provider information.
How to fill out section 1 provider information?
Section 1 provider information should be filled out accurately with all relevant details of the healthcare provider or entity.
What is the purpose of section 1 provider information?
The purpose of section 1 provider information is to ensure proper documentation and identification of the healthcare provider or entity.
What information must be reported on section 1 provider information?
Section 1 provider information must include the provider's name, address, contact information, and any relevant identification numbers.
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